Individual
MICHELLE MULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
31 INDUSTRIAL BLVD, MEDFORD, NY 11763-2220
(631) 924-4411
(631) 924-0563
Mailing address
31 INDUSTRIAL BLVD, MEDFORD, NY 11763-2220
(631) 924-4411
(631) 924-0563
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
317852218
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
317852218
DRIVER LICENSE
NY
Enumeration date
02/27/2017
Last updated
02/27/2017
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